Spine Journal最新文献

{"title":"The association of lumbar intervertebral disc degeneration with low back pain is modified by underlying genetic propensity to pain","authors":"Pradeep Suri MD, MS ,&nbsp;Maryam Kazemi Naeini PhD ,&nbsp;Patrick J. Heagerty PhD ,&nbsp;Maxim B. Freidin PhD ,&nbsp;Isabelle Granville Smith MS ,&nbsp;Elizaveta E. Elgaeva MS ,&nbsp;Roger Compte MS ,&nbsp;Yakov A. Tsepilov PhD ,&nbsp;Frances M.K. Williams PhD, FRCP(E)","doi":"10.1016/j.spinee.2024.05.018","DOIUrl":"10.1016/j.spinee.2024.05.018","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Associations between magnetic resonance imaging (MRI)-detected lumbar intervertebral disc degeneration (LDD) and LBP are often of modest magnitude. This association may be larger in specific patient subgroups.</div></div><div><h3>PURPOSE</h3><div>To examine whether the association between LDD and LBP is modified by underlying genetic predispositions to pain.</div></div><div><h3>STUDY DESIGN</h3><div>Cross-sectional study in UK Biobank (UKB) and Twins UK.</div></div><div><h3>PATIENT SAMPLES</h3><div>A genome-wide association study (GWAS) of the number of anatomical chronic pain locations was conducted in 347,538 UKB participants. The GWAS was used to develop a genome-wide polygenic risk score (PRS) in a holdout sample of 30,000 UKB participants. The PRS model was then used in analyses of 645 TwinsUK participants with standardized LDD MRI assessments.</div></div><div><h3>OUTCOME MEASURES</h3><div>Ever having had LBP associated with disability lasting ≥1 month (LBP1).</div></div><div><h3>METHODS</h3><div>Using the PRS as a proxy for “genetically-predicted propensity to pain”, we stratified TwinsUK participants into PRS quartiles. A “basic” model examined the association between an LDD summary score (LSUM) and LBP1, adjusting for covariates. A “fully-adjusted” model also adjusted for PRS quartile and LSUM x PRS quartile interaction terms.</div></div><div><h3>RESULTS</h3><div>In the basic model, the odds ratio (OR) of LBP1 was 1.8 per standard deviation of LSUM (95% confidence interval [CI] 1.4–2.3). In the fully-adjusted model, there was a statistically significant LSUM-LBP1 association in quartile 4, the highest PRS quartile (OR=2.5 [95% CI 1.7–3.7], p=2.6×10⁻⁶), and in quartile 3 (OR=2.0, [95% CI 1.3–3.0]; p=.002), with small-magnitude and/or nonsignificant associations in the lowest 2 PRS quartiles. PRS quartile was a significant effect modifier of the LSUM-LBP1 association (interaction p≤.05).</div></div><div><h3>CONCLUSIONS</h3><div>Genetically-predicted propensity to pain modifies the LDD-LBP association, with the strongest association present in people with the highest genetic propensity to pain. Lumbar MRI findings may have stronger connections to LBP in specific subgroups of people.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 8-17"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The spinopelvic alignment in patients with prior knee or hip arthroplasty undergoing elective lumbar surgery","authors":"Jan Hambrecht MD ,&nbsp;Paul Köhli MD ,&nbsp;Erika Chiapparelli MD ,&nbsp;Jiaqi Zhu MS ,&nbsp;Ali E. Guven MD ,&nbsp;Gisberto Evangelisti MD ,&nbsp;Marco D. Burkhard MD ,&nbsp;Koki Tsuchiya MD ,&nbsp;Roland Duculan MD ,&nbsp;Franziska C.S. Altorfer MD ,&nbsp;Jennifer Shue MS ,&nbsp;Andrew A. Sama MD ,&nbsp;Frank P. Cammisa MD ,&nbsp;Federico P. Girardi MD ,&nbsp;Carol A. Mancuso MD ,&nbsp;Alexander P. Hughes MD","doi":"10.1016/j.spinee.2024.08.025","DOIUrl":"10.1016/j.spinee.2024.08.025","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Concurrent degeneration of the lumbar spine, hip, and knee can cause significant disability and lower quality of life. Osteoarthritis in the lower extremities can lead to movement limitations, possibly requiring total knee arthroplasty (TKA) or total hip arthroplasty (THA). These procedures often impact spinal posture, causing alterations in spinopelvic alignment and lumbar spine degeneration. It is unclear if patients with a history of prior total joint arthroplasty (TJA) have different spinopelvic alignment compared to patients without.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To assess the relationship between a history of previous THA or TKA, as well as combined THA and TKA, and the spinopelvic alignment in patients undergoing elective lumbar surgery for degenerative conditions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;A retrospective analysis was conducted on patients who underwent lumbar surgery for degenerative conditions. The patients were stratified based on a history of TKA, THA, or both TKA and THA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A total of 632 patients (63% female) with an average age of 64±11 years and an average BMI of 30±6 kg/m&lt;sup&gt;2&lt;/sup&gt; were included.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Patients were stratified based on a history of THA, TKA, or combined THA and TKA. Spinopelvic parameters (lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI)) were assessed. The relationship between spinopelvic alignment and prior TKA, THA or TKA and THA was analyzed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;The data was tested for normal distribution using the Shapiro-Wilk test. We analyzed the relationship between the spinopelvic parameters and the different arthroplasty groups. Differences in scores between groups were examined using ANOVA. Tukey's Honestly Significant Difference test was used for pairwise comparison for significant ANOVA test results. Multivariable linear regression was applied, adjusted for age, sex and BMI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;A total of 632 patients (63% female) were included in the study. Of these patients, 74 (12%) had a history of isolated TKA, 40 (6%) had prior isolated THA, and 15 (2%) had TKA and THA prior to lumbar surgery. Patients with prior arthroplasty were predominantly female (59%) and significantly older (68±7 years vs 63±12 years, p&lt;.001) with a significantly higher BMI (31±6 kg/m&lt;sup&gt;2&lt;/sup&gt; vs 29±6 kg/m&lt;sup&gt;2&lt;/sup&gt;, p&lt;.001). The LL was significantly lower (45.0°±13 vs 50.9°±14 p=.011) in the arthroplasty group compared to the nonarthroplasty group. A history of isolated TKA was significantly associated with lower LL (Est=−3.8, 95% CI −7.3 to −0.3, p=.031) and SS (Est=−2.6, 95% CI −5.0 to −0.2, p=.012) compared to patients without TJA. Prior combined THA and TKA was found to be significantly associated with a higher PT compared to the nonarthroplasty group (Est=5.1, 95% CI 0.4–9.8, p=.034).&lt;/div&gt;&lt;/di","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 45-54"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Types of high-riding vertebral artery: a classification system for preoperative planning of C2 instrumentation based on 908 potential screw insertion sites","authors":"Tomasz Klepinowski MD, PhD ,&nbsp;Natalia Żyłka ,&nbsp;Samuel D. Pettersson ,&nbsp;Jagoda Hanaya ,&nbsp;Bartłomiej Pala ,&nbsp;Kajetan Łątka MD ,&nbsp;Dominik Taterra MD ,&nbsp;Wojciech Poncyljusz MD ,&nbsp;Christopher S. Ogilvy MD ,&nbsp;Leszek Sagan MD","doi":"10.1016/j.spinee.2024.08.021","DOIUrl":"10.1016/j.spinee.2024.08.021","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;Our recent studies indicated that a high-riding vertebral artery (HRVA) is a common variant posing a risk of injuring the vessel during C2 instrumentation. However, several different types fit in the current definition of HRVA, which may require a different strategy for C2 screw placement.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To classify HRVA and provide a clinical aid for preoperative planning of C2 instrumentation. A secondary goal was to estimate coexistence of each HRVA type with the ipsilateral narrow C2 pedicle (NP).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;A retrospective observational study involving radiologic measurements of the estimated number of anonymized cervical computed tomography (CT) scans. STROBE checklist was applied.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A total of 908 potential screw insertion sites (PSIS) of 454 consecutive cervical CT scans were analyzed. The sample size was estimated using ScalaR SP function in RStudio.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;Three types of HRVA based on a series of C2 vertebral morphological parameters including the C2 isthmus height (C2IsH) and C2 internal height (C2InH). Also, the prevalences of each HRVA type and coexisting NP based on the C2 pedicle width (C2PW).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;HRVA was defined as C2IsH of ≤5 mm and/or C2InH of ≤2 mm measured 3 mm lateral to the lateral border of the spinal canal. A narrow pedicle was defined as C2PW of ≤4 mm. Measurements were done using Syn.govia software. Interobserver, intraobserver, and inter-software agreement coefficients for C2IsH, C2InH, and C2PW parameters were adopted from our previous study. K-means cluster analysis was applied.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Prevalence of at least 1 HRVA was 24.9% (n=113 subjects) and 16.2% of PSIS (n=147 sites). Based on the measurements and K-means clustering, the following 3 types of HRVA have been distinguished: type 1—isthmic with only C2IsH being reduced and normal C2InH; type 2—internal with only C2InH being reduced and C2IsH within normal limits; type 3—isthmo-internal with both C2IsH and C2InH being reduced. Kruskal-Wallis test followed by unadjusted and Bonferroni-adjusted posthoc multiple comparison analysis detected significant differences across the types. The prevalences of the newly identified types were as follows: 78.2%, 8.8%, and 12.9% for type 1, type 2, and type 3, respectively. 73.9% of type 1 HRVA, 53.8% of type 2 HRVA, and 100% of type 3 HRVA had a concomitant ipsilateral NP. Prediction of the HRVA types by the K-means clustering has been evaluated. Screw placement techniques for each type are proposed and discussed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;We present the first classification system for the high-riding vertebral artery distinguishing 3 types based on the large homogenous cohort, which may serve as an adjunct to preoperative planning of C2 instrumentation. External validation of this clas","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 59-68"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of incidental dural tears on postoperative outcomes in patients undergoing cervical spine surgery: a multicenter retrospective cohort study","authors":"Yasushi Oshima MD, PhD ,&nbsp;Hideki Nakamoto MD, PhD ,&nbsp;Toru Doi MD, PhD ,&nbsp;Junya Miyahara MD, PhD ,&nbsp;Yusuke Sato MD ,&nbsp;Juichi Tonosu MD, PhD ,&nbsp;Naohiro Tachibana MD, PhD ,&nbsp;Daiki Urayama MD ,&nbsp;Fumiko Saiki MD ,&nbsp;Masato Anno MD ,&nbsp;Naoki Okamoto ,&nbsp;Katsuyuki Sasaki MD ,&nbsp;Shima Hirai MD ,&nbsp;Masahito Oshina MD ,&nbsp;Shurei Sugita MD, PhD ,&nbsp;Kazuhiro Masuda MD ,&nbsp;Sakae Tanaka MD, PhD","doi":"10.1016/j.spinee.2024.09.020","DOIUrl":"10.1016/j.spinee.2024.09.020","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Incidental dural tear (DT) during cervical spine surgery is a feared complication. However, its impact on patient-reported outcomes (PROs) remains unclear.</div></div><div><h3>PURPOSE</h3><div>To determine the influence of DTs on PROs 1 year after cervical spine surgery.</div></div><div><h3>STUDY DESIGN</h3><div>Retrospective cohort.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients undergoing elective cervical spine surgery for cervical spondylosis, ossification of the posterior longitudinal ligament (OPLL), and cervical disc herniation.</div></div><div><h3>OUTCOME MEASURES</h3><div>Analysis included patients’ characteristics, perioperative complications, and PROs both preoperatively and at 1 year postoperatively.</div></div><div><h3>METHODS</h3><div>This study enrolled consecutive patients who underwent elective cervical spine surgery at 13 high-volume spine centers. All patients were required to complete questionnaires both preoperatively and 1 year postoperatively, which included PROs such as numerical rating scales of pain or dysesthesia for each part of the body, Neck Disability Index NDI, and Core Outcome Measures Index. Patients were divided into 2 groups based on the presence (DT+) or absence (DT-) of dural injury. Comparisons were made regarding patient background, perioperative complications, and pre and postoperative PROs. Propensity score matching was also utilized to adjust for patient background, and further comparisons were made regarding complication rates and PROs.</div></div><div><h3>RESULTS</h3><div>Out of 2,704 patients, dural tears were identified in 97 (3.6%) cases. The DT+ group had a significantly higher proportion of fixation surgeries, upper cervical surgeries, OPLL, and revision surgeries. Perioperative complications were significantly higher in the DT+ group, including intraoperative nerve damage, postoperative paralysis, surgical site infections (SSI), and cerebrovascular complications. Outcomes collected from 2,163 patients (79.9%) revealed significantly more severe neck and upper limb pain in the DT+ group. After propensity score matching, significant differences persisted in postoperative paralysis and SSI in the DT+ group, but no significant differences were observed in PROs.</div></div><div><h3>CONCLUSIONS</h3><div>Patients with dural tears showed nearly equivalent postoperative outcomes at 1 year following cervical spine surgery compared to those without dural tears. However, the incidence of perioperative complications was higher, emphasizing the need for careful management.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 91-98"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The establishment of a novel upper cervical complex fracture classification system","authors":"Shangye Li MD ,&nbsp;Xiulian Xu MD ,&nbsp;Mingzheng Chang MD ,&nbsp;Hao Li MD ,&nbsp;Rongkun Xu MD ,&nbsp;Wenyang Fu MD ,&nbsp;Lulu Wang MD ,&nbsp;Yonggang Li MD ,&nbsp;Suomao Yuan MD ,&nbsp;Yonghao Tian MD ,&nbsp;Lianlei Wang MD ,&nbsp;Xinyu Liu PhD","doi":"10.1016/j.spinee.2024.08.013","DOIUrl":"10.1016/j.spinee.2024.08.013","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Upper cervical complex fractures are associated with high rates of neurological damage and mortality. The Dickman's classification is widely used in the diagnosis of upper cervical complex fractures. However, it falls short of covering the full spectrum of complex fractures. This limitation hinders effective diagnosis and treatment of these injuries.</div></div><div><h3>PURPOSE</h3><div>To address the diagnostic gap in upper cervical complex fractures, the study introduces a novel classification system for these injuries, assessing its reliability and usability.</div></div><div><h3>STUDY DESIGN</h3><div>Proposal of a new classification system for upper cervical complex fractures.</div></div><div><h3>PATIENT SAMPLE</h3><div>The study comprised the clinical data of 242 patients with upper cervical complex fractures, including 32 patients treated at our hospital, along with an additional 210 cases from the literature.</div></div><div><h3>OUTCOME MEASURES</h3><div>The interobserver and intra-observer reliability (kappa coefficient, κ) of this classification system were investigated by 3 spine surgeons. The 3 researchers independently reevaluated the upper cervical complex fracture classification system 3 months later.</div></div><div><h3>METHODS</h3><div>The proposed classification categorizes upper cervical complex fractures into 3 main types: Type I combines odontoid and Hangman's fractures into 2 subtypes; Type II merges C1 with odontoid/Hangman's fractures into 3 subtypes; and Type III encompasses a combination of C1, odontoid, and Hangman's fractures, divided into 2 subtypes. Meanwhile, a questionnaire was administered in 15 assessors to evaluate the system's ease of use and clinical applicability.</div></div><div><h3>RESULTS</h3><div>A total of 45 cases (18.6%) unclassifiable by Dickman's classification were successfully categorized using our system. The mean κ value of inter-observer reliability was 0.783, indicating substantial reliability. The mean κ value of intraobserver reliability was 0.862, indicating almost perfect reliability. Meanwhile, thirteen assessors (87.7%) stated that the classification system is easy to remember, easy to apply, and they expressed intentions to apply it in clinical practice in the future.</div></div><div><h3>CONCLUSIONS</h3><div>This system not only offers high confidence and reproducibility but also serves as a precise guide for clinicians in formulating treatment plans. Future prospective applications are warranted to further evaluate this classification system.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 127-135"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The disaggregation of the Oswestry Disability Index in patients undergoing lumbar surgery for degenerative lumbar spondylolisthesis","authors":"Jan Hambrecht MD ,&nbsp;Paul Köhli MD ,&nbsp;Erika Chiapparelli MD ,&nbsp;Krizia Amoroso MD ,&nbsp;Ranqing Lan MS ,&nbsp;Ali E. Guven MD ,&nbsp;Gisberto Evangelisti MD ,&nbsp;Marco D. Burkhard MD ,&nbsp;Koki Tsuchiya MD ,&nbsp;Roland Duculan MD ,&nbsp;Jennifer Shue MS ,&nbsp;Andrew A. Sama MD ,&nbsp;Frank P. Cammisa MD ,&nbsp;Federico P. Girardi MD ,&nbsp;Carol A. Mancuso MD ,&nbsp;Alexander P. Hughes MD","doi":"10.1016/j.spinee.2024.09.001","DOIUrl":"10.1016/j.spinee.2024.09.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND CONTEXT&lt;/h3&gt;&lt;div&gt;The Oswestry Disability Index (ODI), is a widely used patient-reported outcome measure (PROM) for assessing functional status in individuals with lumbar spine pathology. The ODI is used by surgeons to determine the initial status and monitor progress after surgery. Compiled ODI data enables comparisons between different surgical techniques. Degenerative lumbar spondylolisthesis (DLS) often causes symptoms such as back pain and neurogenic claudication affecting quality of life and activities of daily living captured by the ODI. Despite extensive studies on ODI changes after spinal surgery, little is known about the characteristics and changes in the different ODI subsections.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To analyze the baseline characteristics and changes in total ODI and ODI subsections 2 years after elective lumbar surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;Retrospective analysis on patients prospectively enrolled who underwent spinal surgery for degenerative lumbar spondylolisthesis from 2016 to 2018. The ODI was assessed preoperatively and 2 years postoperatively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PATIENT SAMPLE&lt;/h3&gt;&lt;div&gt;A total of 265 patients were included in the study, 60% were female. The mean age of the patients was 67±8 years, and the mean BMI was 30±6 kg/m&lt;sup&gt;2&lt;/sup&gt;.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OUTCOME MEASURES&lt;/h3&gt;&lt;div&gt;The analysis considered the differences in ODI scores before and after surgery, as well as the changes in all ODI subsections 2 years after elective lumbar surgery for DLS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;The analysis evaluated differences in ODI scores and variations in different subsections. Patients without an ODI follow-up at 2 years were excluded from the study. The study utilized the Wilcoxon Signed Rank Test for all prepost paired samples. The Wilcoxon rank sum test was used for sex and procedure comparisons for overall ODI and ODI subsection analysis. Univariate linear regression was applied for overall and subsection specific ODI outcomes with age and BMI as independent variables, respectively. The statistical significance level was set at p&lt;.05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;Improvement in ODI was observed in 242 patients (91%). The highest baseline disability values were found for the questions regarding pain intensity (3.4±1.3), lifting (3.2±1.9), and standing (3.4±1.3). The lowest preoperative functional limitations were observed in sleeping (1.6±1.3), personal care (1.6±1.4), traveling (1.6±1.2) and sitting (1.5±1.4). At the 2-year follow-up, there was significant improvement in all questions and the overall ODI (all p&lt;.001). The ODI subsections that showed the greatest absolute improvements were changing degree of pain (−2.6), with 89% of patients experiencing improvement, standing (−2.4) with 87% of patients experiencing improvement, and pain intensity (−2.1) with 81% of patients experiencing improvement. The subsections with the least improvement were pe","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 99-110"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142180789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the cone-beam CT acquisition trajectory on image quality in spine surgery: experimental cadaver study","authors":"Maxim Fikuart MD ,&nbsp;Benno Bullert MD ,&nbsp;Sven Y. Vetter MD ,&nbsp;Jochen Franke MD ,&nbsp;Paul A. Gruetzner MD ,&nbsp;Benedict Swartman MD","doi":"10.1016/j.spinee.2024.08.016","DOIUrl":"10.1016/j.spinee.2024.08.016","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Intraoperative 3D imaging with cone-beam CT (CBCT) improves assessment of implant position and reduces complications in spine surgery. It is also used for image-guided surgical techniques, resulting in improved quality of care. However, in some cases, metal artifacts can reduce image quality and make it difficult to assess pedicle screw position and reduction.</div></div><div><h3>PURPOSE</h3><div>The objective of this study was to investigate whether a change in CBCT acquisition trajectory in relation to pedicle screw position during dorsal instrumentation can reduce metal artifacts and consequently improve image quality and clinical assessability.</div></div><div><h3>STUDY DESIGN</h3><div>Experimental cadaver study.</div></div><div><h3>METHODS</h3><div>A human cadaver was instrumented with pedicle screws in the thoracic and lumbar spine region (Th11 to L5). Then, the acquisition trajectory of the CBCT (Cios Spin, Siemens, Germany) to the pedicle screws was systematically changed in 5° steps in angulation (−30° to +30°) and swivel (−25° to +25°). Subsequently, radiological evaluation was performed by 3 blinded, qualified raters on image quality using 9 questions (including anatomical structures, implant position, appearance of artifacts) with a score (1–5 points). For statistical evaluation, the image quality of the different acquisition trajectories was compared to the standard acquisition trajectory and checked for significant differences.</div></div><div><h3>RESULTS</h3><div>The angulated acquisition trajectory significantly increased the score for subjective image quality (p&lt;.001) as well as the clinical assessability of pedicle screw position (p&lt;.001) with particularly strong effects on subjective image quality in the vertebral pedicle region (d=1.61). Swivel of the acquisition trajectory significantly improved all queried domains of subjective image quality (p&lt;.001) as well as clinical assessability of pedicle screw position (p&lt;.001).</div></div><div><h3>CONCLUSIONS</h3><div>In this cadaver study, the angulation as well as the swivel of the acquisition trajectory led to a significantly improved image quality in intraoperative 3D imaging (CBCT) with a constant isocenter. The data show that maximizing the angulation/swivel angle towards 30°/25° provides the best tested subjective image quality and enhances clinical assessability. Therefore, a correct adjustment of the acquisition trajectory can help to make intraoperative revision decisions more reliably.</div></div><div><h3>CLINICAL SIGNIFICANCE</h3><div>The knowledge of enhanced image quality by changing the acquisition trajectory in intraoperative 3D imaging can be used for the assessment of critical screw positions in spine surgery. The implementation of this knowledge requires only a minor change of the current intraoperative imaging workflow without additional technical equipment and could further reduce the need for revision surgery.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 154-164"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specific plasma biomarker signatures associated with patients undergoing surgery for back pain","authors":"Perrine Coquelet MSc ,&nbsp;Sandra Da Cal ,&nbsp;Gilles El Hage MD ,&nbsp;Olivier Tastet MSc ,&nbsp;Renaud Balthazard MSc ,&nbsp;Hugo Chaumont MD ,&nbsp;Sung-Joo Yuh MD ,&nbsp;Daniel Shedid MD ,&nbsp;Nathalie Arbour PhD","doi":"10.1016/j.spinee.2024.09.002","DOIUrl":"10.1016/j.spinee.2024.09.002","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Intervertebral disc degeneration (IDD) affects numerous people worldwide. The role of inflammation is increasingly recognized but remains incompletely resolved. Peripheral molecules could access neovascularized degenerated discs and contribute to the ongoing pathology.</div></div><div><h3>PURPOSE</h3><div>To assess a large array of plasma molecules in patients with IDD to identify biomarkers associated with specific spinal pathologies and prognostic biomarkers for the surgery outcome.</div></div><div><h3>DESIGN</h3><div>Prospective observational study combining clinical data and plasma measures.</div></div><div><h3>PATIENT SAMPLE</h3><div>Plasma samples were collected just before surgery. Extensive clinical data (age, sex, smoking status, Modic score, glomerular filtration rate, etc.) were extracted from clinical files from 83 patients with IDD undergoing spine surgery.</div></div><div><h3>OUTCOME MEASURES</h3><div>Recovery 2 months postsurgery as assessed by the treating neurosurgeon.</div></div><div><h3>METHODS</h3><div>Over 40 biological molecules were measured in patients’ plasma using multiplex assays. Statistical analyses were performed to identify associations between biological and clinical characteristics (age, sex, Body Mass Index (BMI), smoking status, herniated disc, radiculopathy, myelopathy, stenosis, MODIC score, etc.) and plasma levels of biological molecules.</div></div><div><h3>RESULTS</h3><div>Plasma levels of Neurofilament Light chain (NfL) were significantly elevated in patients with myelopathy and spinal stenosis compared to herniated disc. Plasma levels of C- reactive protein (CRP), Neurofilament Light chain (NfL), and Serum Amyloid A (SAA) were negatively associated, while CCL22 levels were positively associated with an efficient recovery 2 months postsurgery.</div></div><div><h3>CONCLUSIONS</h3><div>Our results show that CRP and CCL22 plasma levels combined with the age of the IDD patient can predict the 2-month postsurgery recovery (Area Under the Curve [AUC]=0.883). Moreover, NfL could become a valuable monitoring tool for patients with spinal cord injuries.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 32-44"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adipokine dysregulation as an underlying pathology for diffuse ectopic ossification of spinal posterior longitudinal ligament in patients with obesity","authors":"Masahiko Takahata MD ,&nbsp;Yoshinao Koike MD ,&nbsp;Tsutomu Endo MD ,&nbsp;Shiro Ikegawa MD, PhD ,&nbsp;Shiro Imagama MD ,&nbsp;Satoshi Kato MD ,&nbsp;Masahiro Kanayama MD ,&nbsp;Kazuyoshi Kobayashi MD ,&nbsp;Takashi Kaito MD ,&nbsp;Hiroaki Sakai MD ,&nbsp;Yoshiharu Kawaguchi MD ,&nbsp;Itaru Oda MD ,&nbsp;Chikashi Terao MD ,&nbsp;Tomoya Kanto ,&nbsp;Hiroshi Taneichi MD ,&nbsp;Norimasa Iwasaki MD","doi":"10.1016/j.spinee.2024.09.023","DOIUrl":"10.1016/j.spinee.2024.09.023","url":null,"abstract":"<div><h3>BACKGROUND CONTEXT</h3><div>Growing evidence suggests that obesity is implicated in the progression of heterotopic ossification of the posterior longitudinal ligament of the spine (OPLL), a major cause of myelopathy in Asians. However, it remains unclear whether dysregulation of adipokine production due to fat accumulation contributes to OPLL progression.</div></div><div><h3>PURPOSE</h3><div>To determine whether adipose-derived biochemical signals are associated with OPLL development or severity.</div></div><div><h3>STUDY DESIGN/SETTING</h3><div>A nationwide, multicenter, case-control study.</div></div><div><h3>PATIENT SAMPLE</h3><div>Patients with symptomatic thoracic OPLL (T-OPLL) who received treatment between June 2017 and March 2021 and 111 controls without OPLL.</div></div><div><h3>OUTCOME MEASURES</h3><div>OPLL severity index based on whole-spine computed tomography.</div></div><div><h3>METHODS</h3><div>Serum concentrations of adipokines, including leptin (Lep), tumor necrosis factor α (TNFα), and adiponectin (Adpn), as well as the Adpn/Lep ratio—an indicator of adipokine production dysregulation—were compared between the multiple-region OPLL and the single-region OPLL groups. Regression analysis was performed to examine the correlation between adipokine concentrations and OPLL severity index, which was calculated using whole-spine computed tomography images of 77 patients with T-OPLL within 3 years of onset. Using propensity score matching, the adipokine profiles of 59 patients with T-OPLL were compared with those of 59 non-OPLL controls.</div></div><div><h3>RESULTS</h3><div>Patients with multiple-region OPLL exhibited a higher body mass index (BMI), lower serum Adpn/Lep ratio, and higher serum concentration of osteocalcin (OCN) than those with single-region OPLL. The OPLL severity index exhibited a weak positive correlation with BMI and serum Lep levels and a weak negative correlation with the Adpn/Lep ratio. Serum TNFα and OCN concentrations were significantly higher in patients with T-OPLL than in controls with similar age, sex, and BMI.</div></div><div><h3>CONCLUSIONS</h3><div>Patients with diffuse OPLL over the entire spine are often metabolically obese with low Adpn/Lep ratios. In patients with OPLL, TNFα and OCN serum concentrations were essentially elevated regardless of obesity, suggesting a potential association with OPLL development. Considering the absence of therapeutic drugs for OPLL, the findings presented herein offer valuable insights that can aid in identifying therapeutic targets and formulating strategies to impede its progression.</div></div>","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 80-90"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined single-cell RNA sequencing and mendelian randomization to identify biomarkers associated with necrotic apoptosis in intervertebral disc degeneration","authors":"Yi Ye,&nbsp;Lun Wan,&nbsp;Jiang Hu,&nbsp;Xiaoxue Li,&nbsp;Kun Zhang","doi":"10.1016/j.spinee.2024.09.011","DOIUrl":"10.1016/j.spinee.2024.09.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Intervertebral disc degeneration (IDD) is associated with back pain; back pain is a world-wide contributor to poor quality of life, while necroptosis has the characteristics of necroptosis and apoptosis, however, its role in IDD is still unclear. Therefore, the aim of this study was to identify biomarkers associated with necroptosis in IDD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;PURPOSE&lt;/h3&gt;&lt;div&gt;To explore biomarkers associated with necroptosis in IDD, reveal the pathogenesis of IDD, as well as provide new directions for the diagnosis and treatment of this disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN/SETTINGS&lt;/h3&gt;&lt;div&gt;Retrospective cohort study. Our study employs scRNA-seq coupled with MR analysis to investigate the causal relationship between necroptosis and IDD, laying a foundational groundwork for unveiling the intricate pathogenic mechanisms of this condition.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;METHODS&lt;/h3&gt;&lt;div&gt;Data quality control and normalisation was executed in single-cell dataset, GSE205535. Then, different cell types were obtained by cell annotation through marker genes. Subsequently, chi-square test was employed to assess the distribution difference of different cell types between IDD and control to screen key cells. AUCell was applied to calculate necroptosis-related genes (NRGs) scores of all cell types, further key cells were divided into high and low NRGs groups according to the median AUC scores of different cell types. Afterwards, the differentially expressed genes (DEGs) within the 2 score groups were screened. Then, the genes that had causal relationship with IDD were selected as biomarkers by univariate and multivariate Mendelian randomization (MR) analysis. Finally, the expression of biomarkers in different cell types and pseudo-time analysis was analyzed separately.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;In GSE205535, 16 different cell populations identified by UMAP cluster analysis were further annotated to 8 cell types using maker genes. Afterwards, 53 DEGs were screened between the high and low NRGs groups. In addition, 9 genes with causal relationship with IDD were obtained by univariate MR analysis, further multivariate MR analysis proved that &lt;em&gt;NT5E&lt;/em&gt; and &lt;em&gt;TMEM158&lt;/em&gt; had a direct causal relationship with IDD, which were used as biomarkers in this study. This study not only found that the expression levels of &lt;em&gt;NT5E&lt;/em&gt; and &lt;em&gt;TMEM158&lt;/em&gt; were higher in IDD group, but also found that fibrochondrocytes and inflammatory chondrocytes were the key cells of &lt;em&gt;NT5E&lt;/em&gt; and &lt;em&gt;TMEM158&lt;/em&gt;, respectively. In the end, the biomarkers had the same expression trend in the quasi-time series, and both of them from high to low and then increased.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSIONS&lt;/h3&gt;&lt;div&gt;&lt;em&gt;NT5E&lt;/em&gt; and &lt;em&gt;TMEM158&lt;/em&gt;, as biomarkers of necroptotic apoptotic IDD, were causally associated with IDD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CLINICAL SIGNIFICANCE&lt;/h3&gt;&lt;div&gt;The understanding of chondrocytes as key cells provides new perspectives for ","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":"25 1","pages":"Pages 165-183"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}